Michael Botticelli understands all too well the effects alcohol and addiction has had, and continues to have, on the LGBT community. The acting Director of the Office of National Drug Control Policy is not only gay, but also a recovering addict.
“LGBT folks [have] often suffered the consequences of elevating alcohol and drug use, so my own recovery really helps me in a very deep and personal way to understand what we’re trying to accomplish here,” he said. “I go back to my own experience and my own story and I think ‘where were the missed opportunities along the way?’”
Even though data is sparse, according to one report from the Substance Abuse and Mental Health Services Administration (SAMHSA) 20 to 30 percent of the LGBT community abuses substances, while only 9 percent of the general population does so. The Center for Disease Control and Prevention also states that LGBT individuals are more likely to use alcohol and drugs; have higher rates of substance abuse; are less likely to abstain from alcohol and drug use; and are more likely to continue heavy drinking into later life.
For gay and bisexual men the statistics are even more discouraging. According to the book “Unequal Opportunity: Health Disparities Affecting Gay and Bisexual” men who have sex with men are 3.5 times more likely to use marijuana than others; those men are 12.2 times more likely to use amphetamines than others; and they are also 9.5 times more likely to use heroin.
To better understand addiction in the LGBT community Botticelli routinely sets up roundtables with LGBT leaders around the country.
“A lot of times when I travel I will do community roundtables with LGBT leaders…in terms of talking about how do we make sure that that we as a community are addressing the issues,” he said. “…usually I do a lot of listening sessions with LGBT youth to talk about the issues that they see and face. So I really try to do a tremendous amount of outreach to national, state and community level folks in terms of raising the issues around LGBT substance abuse while also looking at community based solutions.”
And what are those issues? Well for the most part, Botticelli said, it comes back to affordable and “competent” healthcare.
When it comes to healthcare for the LGBT community “culturally competent care” is a phrase that Botticelli is fond of saying and repeating. In order for the gay community to receive effective healthcare, and substance abuse treatment, providers must understand the community and be “culturally competent” in LGBT issues.
With Obama’s Affordable Care Act healthcare has become a major priority for his administration and it appears it has even found its way into the administration’s drug strategy by emphasizing that addiction is a disease that needs to be treated in the healthcare system rather than a crime that needs to be punished in the criminal justice system.
“We can’t arrest our way out of the problem,” Botticelli said. “Addiction is a disease. This is a public health related issue. Our strategy will again continue to emphasis that.”
Botticelli said the Obama administration’s strategy is “dramatically” different than previous ones in terms of how addiction is viewed and treated.
“I remember the inaugural strategy for this administration when the director talked about this being a public health issue and about addiction as a disease. And really endorsing a wide variety of evidence based practices, like supporting needle exchange programs and overdose prevention programs,” he explained. “It really both surprised and pleased me the extent to [how much] this drug policy [has changed] under this administration. It has really made a significant change in terms of how we deal, from a national perspective, with issues of substance use.”
Botticelli has a long history of working with drug policy and addiction. Before his current position he served as deputy director since November 2012. Before that he served as director of the Bureau of Substance Abuse Services at the Massachusetts Department of Public Health, where he expanded prevention, intervention, treatment, and recovery services for the state.
But his work in this field all started more than 20 years ago when he only had 2 years sober and started working with treatment programs in Massachusetts.
“I wanted to develop a specialty track for LGBT people within the treatment program. So part of my job was to do outreach to the LGBT community in Boston and work with a treatment program to design a specialty track for LGBT folks,” he said. “From there I started working at the Massachusetts Health Department where I worked in our HIVAIDS division.”
While this year’s drug strategy has yet to be released, Botticelli said it would continue to treat addiction as a disease and a public health related issue.
As to why LGBT people suffer from higher rates of substance abuse he can only speculate.
“There are lots of reasons and speculation as to why,” he said. “When you look at any historically disenfranchised minority population, including LGBT folks, we historically have seen elevated issues around substance abuse related issues.”
Botticelli also believes that because for so long the only way for gays and lesbians to meet were in bars, that “bar” culture subsequently led to higher rates of alcohol consumption and abuse. Much of Botticelli’s own substance abuse revolved around the bar culture.
And it all started on the day he came out of the closet.
“[The night] I came out, someone took me to a gay bar,” Botticelli recalled. “I think it’s particularly telling to me that the first thing someone said to me is ‘oh you’re gay, you need to go to this bar.’ And it was actually a straight person that took me to a gay bar.”
Another example of this bar culture Botticelli points out is the amount of alcohol ads found in gay publications.
“You’ll see an inordinate amount of alcohol advertising,” he said. “So historically the [LGBT community] has been targeted by the alcohol industry because they know there is elevated alcohol use. We have a responsibility as a community to change that kind of normative view, that sometimes alcohol and drug use is part and parcel of what it means to be gay.”
Botticelli recognizes that technology is changing LGBT culture and how gays and lesbians meet each other and bars aren’t quite as important anymore. Yet there is still a significant problem of substance abuse rates within the community.
“I found it very, very hard to think of myself as a gay man who didn’t drink and do drugs,” he said.
Fortunately for Botticelli that’s no longer the case. Today he has more than 25 years of sobriety under his belt.
“[But it wasn’t] until I got sober that I found that there was this incredibly vibrant recovery community of gay men,” he said. “So how do we promote the positive image that recovery can play? And how do we make sure we have a vibrant and visible recovery community within the LGBT community to show people that there is a way to have a really happy life on the other side of substance abuse.”
Education and prevention is key, he said.
“A lot of our prevention work is focused on how do we change community norms so that substance abuse issues are not endemic in the community,” he said. “And working with our medical providers to do prevention and intervention work. And making sure people have good culturally competent care and treatment.”
Right now a hot topic across the U.S. is marijuana use. States are either legalizing recreational use or medicinal use. Florida is one of them. In November voters will vote on Amendment 2, which would legalize medicinal use. While the federal government continues to be anti-marijuana, traditional opponents are, in some cases, evolving. Even Republican Governor Rick Scott has signaled he will sign a bill into law allowing for the use of Charlotte's Web, a buzz-free strain of pot, that can be given to children with debilitating seizures and also be prescribed to some patients who suffer from cancer, Parkinson's disease, multiple sclerosis and other very severe ailments.
“We don’t look at [marijuana use] as a political issue, we look at this as a public health related issue,” Botticelli said. “We rely on science and research to guide our way. In the U.S., based on the last national survey of high school students, it showed that we now have more students 12-17 years old smoking marijuana than tobacco. We see more adolescents in treatment as a result of marijuana dependency issues.”
One of the reasons for the increased rate of use Botticelli believes is that the perception of marijuana as a harmful substance is changing and that people, especially adolescents, no longer believe it’s harmful.
“When youth see that marijuana has a medicinal purpose…they don’t see marijuana use as harmful,” he said. “We know [marijuana use] is related to a wide variety of health related issues such as poor academic performance. A study showed regular marijuana use can reduce IQ. We know that one in nine people who use marijuana become dependent on it. So we have to look at the science and data to guide our policy on this issue. We know that many people who become addicted to prescription drugs or heroin often start their drug use at a very early age. And they often start with alcohol, tobacco and marijuana — often in combination. From a prevention standpoint we want to make sure our youth, are not turning to these substances, because we know there are life long implications.”
But despite Botticelli’s line of reasoning even some supporters of the Obama administration are breaking with the federal government on the issue of marijuana. In February, while Botticelli was still deputy director, he came under fire from Rep. Gerry Connolly (D-VA) during a House Oversight Committee hearing, and was reluctantly forced to admit that marijuana is less harmful than alcohol. During the back and force exchange Botticelli attempted to dodge the question several times but Connolly wouldn’t let up and continued to press him.
“Is it not a scientific fact that there is nothing comparable with marijuana?” Connolly asked. “And I’m not saying it’s good or bad, but when we look at deaths and illnesses, alcohol, other hard drugs are certainly — even prescription drugs — are a threat to public health in a way that just isolated marijuana is not. Isn’t that a scientific fact? Or do you dispute that fact?”
“I don’t dispute that fact,” Botticelli finally replied.
And in an interview with David Remnick, editor of the New Yorker, President Obama made a few statements that might signal a softening stance on the federal government’s long-standing views on marijuana.
“As has been well documented, I smoked pot as a kid, and I view it as a bad habit and a vice, not very different from the cigarettes that I smoked as a young person up through a big chunk of my adult life,” he told the New Yorker. “I don’t think it is more dangerous than alcohol.”
It remains to be seen whether Botticelli will be officially appointed to the position of director, informally known as the U.S. Drug Czar. But one thing is almost for certain, Botticelli’s sexuality will not be a factor. President Obama hasn’t shied away from appointing high-ranking openly gay officials in the past. In fact according to the Gay & Lesbian Victory Institute he’s has appointed more than 250 openly LGBT professionals to full-time and advisory positions in the executive branch; more than all known LGBT appointments of all other presidential administrations combined.